DDAVP (desmopressin) Medical Benefit Medication Utilization Policy
Defines coverage criteria for initial and continuation approval of desmopressin (DDAVP) for diabetes insipidus, Hemophilia A, and von Willebrand Disease; includes quantity limits, authorization period, and applicable HCPCS code(s).
No material changes
Coverage Summary
Defines coverage criteria for initial and continuation approval of desmopressin (DDAVP) for diabetes insipidus, Hemophilia A, and von Willebrand Disease. Initial approval requires the medication be prescribed by, or in consultation with, an endocrinologist for diabetes insipidus or prescribed by, or in consultation with, a hematologist for Hemophilia A or von Willebrand Disease. Continuation requires diagnosis of one of the listed indications, that the medication be prescribed by, or in consultation with, a hematologist or endocrinologist, and documentation that the patient is being monitored and responding appropriately to treatment. The policy is designated as a medical-benefit medication and lists applicable HCPCS code(s) for billing purposes.
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